Percutaneous noncoronary interventions during continuous mechanical chest compression with the LUCAS-2 device

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The LUCAS 2 Chest Compression Device Is Not
Always Efficient: An Echographic Confirmation
Article in Annals of emergency medicine · February 2014
DOI: 10.1016/j.annemergmed.2014.01.020 · Source: PubMed
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Case Report
Percutaneous noncoronary interventions during
continuous mechanical chest compression with the
LUCAS-2 device☆
Abstract
Cardiac arrest in the catheterization laboratory during
percutaneous coronary interventions (PCI) is associated with
high mortality, among other things because it may be
difficult to perform efficacious cardiopulmonary resuscita-
tion while continuing the coronary intervention. We report
on 2 patients who have benefit from ongoing external
mechanical chest compression with LUCAS-2 device
because of cardiac arrest occurred during non-coronary
interventions. Added to the existing data on PCIs performed
during cardiac arrest, these first reported cases suggest that
the application of the LUCAS-2 device in the cardiac
catheterization laboratory may be also expanded to patients
undergoing noncoronary interventions.
Percutaneous coronary interventions during cardiac arrest
may be attempted even if performing adequate coronary
revascularisation under this reanimation condition may result
very challenging. A novel mechanical chest compression
device, LUCAS-2 (Lund University Cardiopulmonary
Assistance System; Lund, Sweden) [1] delivers automatic
chest compression and active decompression. Although few
reports on the application of this device during PCI have
been published [2], here the authors describe their prelim-
inary experience with 2 patients who have benefit from this
device during non-coronary interventions.
Patient 1: an 84-year-old man was found unconscious in
his hospital room with pulseless electrical activity one day
after elective hip surgery. After several minutes of standard
cardiopulmonary resuscitation (CPR), the patient regained
circulation but remained dependent on high dose of
catecholamines. Emergent transthoracic echocardiography
confirmed the clinical suspicion of a massive PE. Thereafter,
two additional episodes of pulseless electrical activity
necessitating short periods of CPR and an increasing dose
of vasopressors occurred. Because of the absolute contrain-
dication for systemic thrombolysis (ie, day 1 after major
orthopedic surgery), it was decided to attempt a percutaneous
mechanical pulmonary thrombectomy.
The first pulmonary angiography showed a maintained
left pulmonary flow, whereas the selective right pulmonary
angiography showed a total occlusion of the superior middle
lobar arteries and a subocclusion of the inferior lobar artery
(Fig. 1).
Immediately after the right pulmonary angiography, the
patient developed a fourth cardiac arrest requiring CPR.
Because the scheduled rheolytic pulmonary mechanical
thrombectomy was not immediately available (ie, ≈5
minutes were necessary to install the Angiojet device
[Medrad/Possis Medical Minneapolis MN]), we decided at
that moment to switch to a mechanical external chest
compression performed with the LUCAS-2 device and to
perform a rotational pigtail fragmentation of the right
pulmonary thrombi. Under external chest compression with
the LUCAS-2 device, the fragmentation of the superior and
middle lobar occlusion was rapidly performed (Fig. 2A-B)
without interruption of CPR. In addition, local thrombolysis
(ie, 20 mg of Alteplase) was administered directly in the
occluded lobar arteries, and LUCAS-2 external chest
compression was continued for a total of 20 minutes to
allow the lytic agent to sufficiently circulate in the
pulmonary circulation.
Subsequently, the patient regained sufficient pulmonary
(Fig. 3) and systemic organ perfusion and LUCAS-2 was
definitively stopped before transfer to the intensive care
unit. The restoration of a spontaneous circulation was
corroborated by the concomitant increase of the cardiac
output from 3.9 L/min into 5.6 L/min and with the increase
of the arterial pressure from 89/44 prior the cardiac arrest to
112/76 mm Hg. However, 2 days after, the patient died
after multi-organ failure.
Patient 2: a 75-year-old male, known for asymptomatic
severe aortic stenosis (mean gradient = 50 mm Hg, valve
area = 0.6 cm 2 ), was transferred to our catheterization
laboratory for a rescue PCI after fibrinolysis failure for an
extensive anterior ST-elevation myocardial infarction. The
coronary angiography showed a proximal left anterior
descending artery occlusion. During PCI, the patient
developed pulseless electrical activity and CPR was
immediately started with the LUCAS-2. Under mechanical
reanimation the PCI was completed. Despite TIMI 3
coronary flow, the patient did not regain a sufficient
☆ Disclosure: authors do not have any potential conflict of interest
regarding the present manuscript.
www.elsevier.com/locate/ajem
0735-6757/$ – see front matter © 2012 Published by Elsevier Inc.
American Journal of Emergency Medicine (2012) xx, xxx–xxx